Relationships between language-based disability and quality of life in chronically aphasic adults

Abstract

Background: A growing consensus among speech-language pathologists that treatment goals should be significant to the consumer and society has spurred clinicians to address stroke survivors' quality of life (QOL) as a possible target for remediation. Use of formal measures to detect decreased QOL presumes that test performance of aphasic patients is different from that of non-brain-injured (NBI) adults. Treatment directed towards decreased QOL presupposes that its symptoms are attributable to a diagnosis of aphasia. Differential performance for chronically aphasic and NBI adults on two QOL measures has been established. However, relationships between residual language and/or communication deficits and QOL have not been confirmed. Aims: We examined relationships between residual language and/or communication deficits and QOL to determine whether, within NBI adult and chronically aphasic adult groups, there are significant relationships between language impairment and QOL measures; whether there are significant relationships between communication activity limitation and QOL measures; and, whether the strengths of these relationships differ between groups. Methods & Procedures: A total of 18 NBI controls and 18 adults with chronic aphasia were administered two language impairment tests (WAB, PICA), two communication activity limitation assessments (CADL-2, ASHA FACS), and two QOL measures (WHOQOLBREF, PWI). Correlation analyses were used to examine relationships between residual language and/or communication deficits and QOL. Outcome & Results: Although chronically aphasic adults scored significantly lower on all measures than did NBI adults, language-based disability generally was not significantly related with QOL in either group. Within the NBI group, only one language impairment and one QOL measure were significantly related. Within the chronically aphasic group, there were no significant relationships between language impairment and QOL measures, and there were no significant between-groups differences in the strengths of these relationships. Within either group, there were no significant relationships between communication activity limitation and QOL measures. Furthermore, there were no significant between-groups differences in the strengths of these relationships. Conclusions: The results of this investigation may be interpreted to suggest that decreased QOL in chronically aphasic adults is not closely related with language-based disablement. Thus, speech therapy that directly targets QOL in aphasic patients may not be justified. However, the use of correlational analysis limits the ability to rule out viable, alternative hypotheses or to account for misinterpretation due to measurement error. To examine relationships between language-based disablement, other undetermined factors, and QOL, further study, using larger sample sizes and causal modelling techniques, is recommended.